Higher Body Fat in Children and Adolescents With Type 1 Diabetes-A Systematic Review and Meta-Analysis

Abstract

Aims: Higher prevalence of overweight and obesity in children and adolescents with type 1 diabetes (T1D) suggests alterations are required in body composition. However, differences in body composition between children with T1D and typically developing children (TDC) have not been synthesized using meta-analysis. Therefore, we conducted a systematic review and meta-analysis to compare body composition between children with T1D and TDC, and to explore the role of disease and non-disease related factors in potential body composition differences.

Methods: Studies were performed comparing dual-energy x-ray absorptiometry-acquired total body fat and lean mass, absolute (kg) and relative (%) values, between children with T1D and TDC. We reported mean differences with 95% confidence intervals (CI) from meta-analysis and relative between-group %-differences. We used meta-regression to explore the role of sex, age, height, body mass, body mass index, Hemoglobin A1c, age of onset, disease duration, and insulin dosage in the potential body composition differences between children with T1D and TDC, and subgroup analysis to explore the role of geographic regions (p < 0.05).

Results: We included 24 studies (1,017 children with T1D, 1,045 TDC) in the meta-analysis. Children with T1D had 1.2 kg more fat mass (kg) (95%CI 0.3 to 2.1; %-difference = 9.3%), 2.3% higher body fat % (0.3-4.4; 9.0%), but not in lean mass outcomes. Age of onset (β = -2.3, -3.5 to -1.0) and insulin dosage (18.0, 3.5-32.6) were negatively and positively associated with body fat % mean difference, respectively. Subgroup analysis suggested differences among geographic regions in body fat % (p < 0.05), with greater differences in body fat % from Europe and the Middle East.

Conclusion: This meta-analysis indicated 9% higher body fat in children with T1D. Earlier diabetes onset and higher daily insulin dosage were associated with body fat % difference between children with T1D and TDC. Children with T1D from Europe and the Middle East may be more likely to have higher body fat %. More attention in diabetes research and care toward body composition in children with T1D is needed to prevent the early development of higher body fat, and to minimize the cardiovascular disease risk and skeletal deficits associated with higher body fat.

Keywords: adolescents; body composition; body fat; children; dual energy x-ray absorptimetry; lean mass; type 1 diabetes (T1D).

Figure 1

PRISMA 2020 flow diagram illustrating search and screening results.

Figure 2

Forest plots illustrating pooled analyses of mean difference of (A) fat mass (kg); and (B) body fat % compared children with T1D to TDC, with upper and lower limits showing 95% confidence intervals.

Figure 3

Meta-regression graph illustrating the association between age of onset (years) and body fat % mean difference, with 95% confidence intervals (CI) of body fat % compared children with T1D to TDC. The size of the circles represents the weight given to each individual study in the meta-analysis. Larger circles indicate a higher weighting.

Figure 4

Meta-regression graph illustrating the association between insulin dosage (U/kg/day) and body fat % mean difference, with 95% confidence intervals (CI) of body fat % compared children with T1D to TDC. The size of the circles represents the weight given to each individual study in the meta-analysis. Larger circles indicate a higher weighting.

Figure 5

Forest plot of subgroup analysis illustrating the pooled means of body fat % across different geographic regions.